The inspection took place on 10 June 2015 and was unannounced. This meant the provider or staff did not know about our inspection visit.

Butterwick Hospice provides care for up to 10 day care patients Monday to Friday. The hospice provides a sitting service within the community, a range of complementary therapies including physiotherapy and family support.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

There were sufficient numbers of staff on duty in order to meet the needs of people using the service. The provider had an effective recruitment and selection procedure in place and carried out robust checks when they employed staff.

We saw evidence that the provider and staff had a thorough knowledge of safeguarding. Staff had easy access to policies and procedures.

We saw a copy of the provider’s complaints policy and procedure and saw that complaints and concerns were always taken seriously.

Training records were up to date and staff received regular supervisions, appraisals and a personal development plan was also completed, which meant that staff were properly supported to provide care to people who used the service.

We saw staff and volunteers supporting people in the dining rooms at lunch and a variety of choices of food and drinks were being offered.

All of the care records we looked at contained care plan agreement forms, which had been signed by the person who used the service or a family member.

The hospice was exceptionally clean, spacious and suitably adapted for the people who used the service.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We discussed DoLS with the registered manager and looked at records. We found the provider was following legal requirements in the DoLS.

People who used the service were extremely complimentary about the standard of care and support provided.

We saw staff supporting and helping to maintain people’s independence. We saw staff treated people with dignity, compassion and respect and people were encouraged to remain as independent as possible.

We saw that the hospice had a full programme of activities in place for people who used the service, including a range of complementary therapies.

All the care records we looked at showed people’s needs were assessed before they attended the hospice and we saw care plans were written in a person centred way.

The provider had a robust quality assurance system in place and gathered information about the quality of their service from a variety of sources including people who used the service and their family and friends.

During our inspection we asked the provider, staff and obtained comments from people who used the service about the following; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, comments from people using the service and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People's comments included;

"I expected to meet others with similar problems but did not appreciate how much benefit I would get from having a 'me day'.

"Having contact with other people who had experienced the same things that I have has helped me a lot.".

"Coming here has given me confidence, it's a change of scenery and it's good to meet other people".

"All the staff and volunteers can't do enough for me. I appreciate everything".

"I look forward to coming to the day hospice because it's a day when my family don't have to worry about me". "it has definitely aided my recovery".

"It is the best thing that has ever happened to me in respect of getting back to life after being so ill".

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

We saw the service had not had to make any safeguarding referrals in the past 12 months but processes were in place to support staff if it was required to do so.

We saw that the service promoted equality, diversity and human rights, and adhered to the government's 'End of Life Care Strategy' that highlighted the importance of being treated as an individual and with dignity and respect. We saw people were consulted about their preferred place of care.

The hospice had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The manager told us no applications had needed to be submitted. However we found relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant people were safeguarded as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

Is the service effective?

There was an advocacy service available if people needed it, this meant people could access additional support when required.

People’s health and care needs were assessed with them, and they or their representatives were involved in writing their plans of care. Specialist dietary, social, mobility, equipment and pain control care needs had been identified in care plans where required.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical, memory and mental health impairments.

Visitors were able to see people in private and that visiting times were flexible.

Is the service caring?

We saw staff and volunteers showed patience and gave encouragement when supporting people.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised, we saw these had been addressed by the provider.

People’s preferences, interests, aspirations and diverse needs were recorded and care and support was provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. The hospice had its own adapted transport, which helped to keep people involved with their local community. This was also used to transfer people to the day hospice.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system. The records we looked at showed any shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the hospice and the quality assurance systems in place. This helped to ensure that people received a good quality service.

Staff told us they felt supported in their role and we saw staff supported each other throughout the inspection.

People or their relatives were able to give consent to the care, treatment and support they received. Comments on the patient satisfaction survey (November 2012) to the question did you receive a clear explanation of the service available included “they were very informative” and “just the right amount of information”.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We spoke with three people who used the service. They were all very positive about the care and support received. Comments included “I really enjoy meeting the other patients and staff – they give me lots of support” and “the staff are so friendly”.

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained.

People had their health and welfare needs met by sufficient numbers of appropriate staff.

People’s personal records were accurate and fit for purpose.

People who used the service told us they understood the care and support services available to them, and that they were involved in making decisions about them.

People told us they were treated respectfully by staff and the support the hospice could provide was clearly explained to them before they choose to attend the day hospice.

Everyone we spoke to was very happy with the care and support they received. One person told us with the support of a physiotherapist he used the hospice gym which he thought helped him a lot.

People told us “There is a lovely friendly atmosphere here”. “The staff are very kind and caring”

Butterwick Hospice Bishop Auckland had a day care service where people could enjoy social activities and a variety of treatments and therapies, including physiotherapy and aromatherapy. The day care service offered 16 places a day, 4 days a week, including daycare for specialist disease groups.

The hospice also offered outreach day centres held at local hospitals which allowed people to receive day centre services closer to home. The palliative home care service provided personal care and support for people in their own homes.

We spoke with some people using the day service and the palliative home care service. People were overwhelmingly positive about the services they received. Their comments included:

“I get lots of information here that I wouldn’t have known about – they even brought in the benefits agency and I found out about benefits that I’d never heard of before.”

“Someone always rings us up to let us know who is coming to visit.”

“I also have access to many other (nursing) services that I would struggle to see if I wasn’t coming here.”

“The staff are great, they’re always there to help with anything you ask for.”

“They’re always asking for feedback, always asking us whether things are a benefit to us or not.”

“It’s a fantastic service - it’s a godsend.”

“If it wasn’t for this service I would have given up. I wouldn’t be here without this service.”

“The physio and aromatherapy are brilliant.”

“It depends on my stage. Each week I let the physiotherapist know what I need and they gear the exercises for me – and my needs can change every week, so I have a full say in what my treatment is.”

“The staff are superb, I can’t fault them.”

“The physios and aromatherapists are brilliant – I wish I could have them everyday.”

“They give us feedback forms to fill in all of the time, they’re very good here and they want to make the service the best it can be for us.”